Huge gaps in bone and soft tissue sarcoma treatment

Bone and soft tissue cancer (sarcoma) is a rare form of highly malignant, easily misdiagnosed cancer that requires complicated treatment – a host of challenges that make its treatment in Vietnam remains a big gap. This situation leads to remarkable disadvantages for the majority of patients.

Why do patients with Sarcoma rapidly develop lung metastases?

12-year-old Khanh Tho was diagnosed with stage IIB left tibial bone sarcoma in mid-2021. She received 2 cycles of neoadjuvant chemotherapy before surgery, and was then taken to Vinmec Times City International Hospital for surgery by her family. After undergoing a limb-sparing surgery to remove the entire tumor in her knee joint, she received 4 cycles of adjuvant chemotherapy. However, just over a year later, Tho developed lung metastases.

Studying the treatment process of Tho, Prof. Dr. Tran Trung Dzung – Director of Vinmec Orthopedics & Sports Medicine Center remarked that Tho’s disease did not locally recur, which meant that the surgery results were great. The pathological results showed a poor tumor necrosis response rate at under 80%, so the rapid development of lung metastasis may be due to the insufficient doses of preoperative chemotherapy, as in other cases Prof. Dzung had encountered.

After a surgery, the patients with bone sarcoma often receive further adjuvant chemotherapy to eradicate all remaining cancer cells. The preferred chemotherapy protocol typically often includes high-dose methotrexate. In such cases, the patients will be confronted by leukopenia, immunodeficiency, and increased risk of infection, so they must be cared for in sterile isolation rooms. In addition, the use of high doses of Methotrexate can lead to a wide range of serious complications such as toxicity, strokes, and even death. Therefore, the hospital must regularly examine the concentration of this active ingredient in the patient’s blood. However, there are only a few organizations where such examination is performed regularly and a standard sterile care room is available, so the doctors often do not risk using the adequate dose of Methotrexate, but choose to lower the dose or extend the intervals among chemotherapy cycles. This resulted in the situation where 85% of patients undergoing chemotherapy still have an increased risk of disease progression, and more than 50% will be found with a recurrence of pulmonary metastasis.

A similar case to Khanh Tho was Ngoc Hoa (9 years old, in Hanoi), who suffered from stage IIB cancer, yet she was provided with proper treatment with much more positive progress. Immediately after her bone sarcoma was detected in November 2022, she was taken to Vinmec Orthopedics & Sports Medicine Center by her parents. Since Vinmec has a specialized center for bone cancer, Hoa’s entire process of diagnosis and treatment, including biopsy, surgery, pre- and post-operative chemotherapy within 9 months, was conducted properly. In addition to the application of the appropriate dose and the right protocol of chemotherapy, side effects were carefully anticipated to minimize their impacts on the patient’s body. At the end of the treatment, the tumor necrosis rate of Ngoc Hoa was 100%, which meant all cancer cells were eradicated. It has been 6 months after her last adjuvant chemotherapy, and she has shown no symptoms of metastasis.

From rare to… difficult

Sarcoma is the common name for all types of cancer beginning in the bones, soft tissues (tendons, muscles, fat), and some types of gastrointestinal stromal tumors (GIST). The most common is still bone and soft tissue sarcoma which is classified as a rare cancer. Only about 200-300 cases of bone sarcoma are recorded each year in hospitals across Vietnam, compared to tens to hundreds of thousands of other cancer cases.

Due to its rarity, the investment in human resources and facilities for its examination and treatment has not been given due attention. Bone sarcoma is often detected at school age with non-specific onset symptoms, typically transient leg and arm pains. On the radiograph – the primary means of screening, the image of bone sarcoma cells is often vague, so only a doctor with specialized expertise can spot it.

Therefore, the diagnosis of bone sarcoma is easily overlooked or mistaken for pains caused by bone growth or excessive movement. Only when the location of the tumor turns swollen, the tumor breaks when the child plays sports, inducing compression to change the body movement and influence to the bone structure, will the patient be diagnosed. According to statistics, 80% of bone sarcoma cases are in stage IIB – the sub-classification deemed relatively late. At this stage, bone sarcoma has broken the bone’s outside shell and 50% has  metastasized.

In addition to its rareness and difficulty in detection, the complexity in treatment has made bone sarcoma a tremendous challenge in Vietnam today.

Bone cancer (Osteosarcoma) is classified into a wide array of groups (osteosarcomas and chondrosarcomas, etc.), and can be further divided into subtypes (cortical- and medullary-based tumors). Accurate pathological diagnosis along with bone scintigraphy is critical to guide treatment. Accordingly, depending on the subtype, the treatment is also an arduous process. In some cases, only surgery is needed, others may require a combination of pre- and post-operative chemotherapy and radiotherapy, etc. This entire protocol requires a smooth combination of surgical methods, time-selective radiotherapy, and appropriate dosages to achieve positive overall results.

Up to 95% of osteosarcoma cases are with tumors present in the legs or hands. The amputation of the limb is not only psychologically devastating for the patients but also results in acute stress for the families. Meanwhile, the majority of osteosarcoma cases are now treated as a tumor by curettage, bone cementing and grafting. A study at the National Cancer Hospital showed that 30% of the amputation-indicated cases refused treatment and went home.

In order to successfully treat osteosarcoma, a “conductor” to coordinate throughout this process will be indispensable. Recognizing that gap, Vinmec is the trailblazer in Vietnam that has established a Bone and soft tissue cancer treatment center – Vinmec Sarcoma Center with abundant human resources including bone and soft tissue orthopedic surgeons, chemotherapists, and other specialists such as nutritionists, psychologists, etc. Each patient can be offered medical consultation with the Bone-specialized Oncology Council for an optimal protocol.

The requirement of limb restoration for patients with bone and soft tissue sarcoma to facilitate the living re-integration of patients is mandatory at Vinmec. Therefore, each member of Vinmec Sarcoma Center, not only specializes in surgery for sarcoma patients but also devotes to scientific research, learning, and participating in international conferences and overseas courses to improve their expertise for effective treatment application for Vietnamese patients.

“Vinmec Sarcoma Center is being evaluated by Cleveland Clinic, a world-renowned center for sarcoma treatment. Vinmec’s aspiration is not only to improve the effectiveness of treatment but also to conduct valuable scientific research on sarcoma to fill the significant existing gaps in Vietnam” – Prof. Dr. Tran Trung Dzung shared.